Physician Reimbursement Primer for Cardiac ... - Boston Scientific

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Chapter 5 • Temporary pacing is not included and should be reported separately (33210 or 33211). • Extraction of chronic lead is not included and should be reported separately (33234 or 33235). • If a full and complete diagnostic subclavian venogram is performed (medical necessity established, images obtained and findings documented), report it separately with codes 36005 and 75820. Code 36005 may need modifier 59 attached. If subclavian venogram is performed to determine vein patency or for roadmapping purposes, code 75820 and 36005 should not be billed. • If fluoroscopic guidance is documented, report code 71090. Assign modifier 26 to describe the professional component of hospital-based services. Check with individual payers regarding separate payment for 71090, as some payers may consider this bundled into the device-implant code. • Current AMA guidance is that the mapping of the coronary sinus by contrast injection is included within the new codes. Code 75860 (venography, sinus or jugular) should not be reported separately. • If biventricular lead insertion into the coronary sinus is unsuccessful (failed attempt), for physician professional claims assign modifier 52 (reduced services) or 53 (discontinued service) to codes 33224 and 33225 as appropriate. Assign modifier 74 (discontinued service after administration of anesthesia) for hospital outpatient claims. Verify the policy of your local payer. Ensure that the documentation supports that the majority of work has been performed (such as “multiple attempts, venogram”). Pacemaker Lead (Electrode) Repositioning (33215, 33226) 33215 Repositioning of previously implanted transvenous pacemaker or pacing cardioverter-defibrillator (right atrial or right ventricular) electrode 33226 Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of generator) Documentation and Billing Tips • Disconnection of leads, reconnection of leads, reprogramming of parameters, and testing of leads and pulse generator are included in these codes for pacemaker devices. For ICD or CRT-D devices, defibrillator threshold testing of lead(s) and/or pulse generator is separately billable by codes 93640–93642. • If fluoroscopic guidance is documented, report code 71090. Assign modifier 26 to describe the professional component of hospital-based services. Check with individual payers regarding separate payment for 71090, as some payers may consider this bundled into the device-implant code. • The term “repositioning” has been transferred to code 33215. • The restriction of “15 days or more” postoperative has been deleted. • Modifier 59 may be applicable, if a lead is replaced on the same day of service as previous implant. • Temporary pacing is included and should not be reported separately. Pacemaker Lead (Electrode) Removal (33234, 33235) 33234 Removal of transvenous pacemaker electrode(s); single lead system, atrial or ventricular 33235 Removal of transvenous pacemaker electrode(s); dual lead system 28 Physician Reimbursement Primer for Cardiac Rhythm Management
Documentation and Billing Tips Coding Overview • Extraction is coded the same regardless of the method—traction, snare, or extraction devices. • No additional coding is required if more than two leads are removed. • Code separately for removal of the existing pulse generator, if it is replaced (33233). • Code separately for the replacement of a new pacemaker generator (33212 or 33213). • If a lead is inserted in addition to replacing the pulse generator, report the procedure with code 33206–33208 as appropriate. • If a full and complete diagnostic subclavian venogram is performed (medical necessity established, images obtained and findings documented), report it separately with codes 36005 and 75820. Code 36005 may need modifier 59 attached. If subclavian venogram is performed to determine vein patency or for roadmapping purposes, code 75820 and 36005 should not be billed. • If fluoroscopic guidance is documented, report code 71090. Assign modifier 26 to describe the professional component of hospital-based services. Check with individual payers regarding separate payment for 71090, as some payers may consider this bundled into the device-implant code. Pacemaker Lead (Electrode) Repair (33218, 33220) 33218 Repair of single transvenous electrode for a single-chamber, permanent pacemaker or single-chamber pacing cardioverter-defibrillator 33220 Repair of two transvenous electrodes for a dual chamber permanent pacemaker or dual chamber pacing cardioverter-defibrillator Documentation and Billing Tips • Do not report twice if both electrodes are repaired. • Code separately for the replacement with new pacemaker generator (33212 or 33213). • Temporary pacing is not included and should be reported separately (33210 or 33211). • Disconnection of leads, reconnection of leads, reprogramming of parameters, and testing of leads and pulse generator are included in these codes for pacemaker devices. For ICD or CRT-D devices, defibrillator threshold testing of lead(s) and/or pulse generator is separately billable by codes 93640–93642. Physician Reimbursement Primer for Cardiac Rhythm Management 29
Page 1 and 2: GuidePoint GuidePoint is simplifyin
Page 3 and 4: Contents Chapter 1: Introduction ..
Page 5: How This Guide Is Organized Ablatio
Page 8 and 9: Chapter 1 Acronym Term CRM cardiac
Page 10 and 11: Chapter 2 detail below). This payme
Page 12 and 13: Chapter 2 procedure, the hemodynami
Page 14 and 15: Chapter 2 MS-DRG Logic for CRM Proc
Page 16 and 17: Chapter 2 10 Physician Reimbursemen
Page 18 and 19: Chapter 3 relatively rare, they can
Page 20 and 21: Chapter 3 3. Sino-atrial block or s
Page 22 and 23: Chapter 3 Since there are more than
Page 24 and 25: Chapter 3 c. Ejection fractions mus
Page 26 and 27: Chapter 3 At this time there is no
Page 28 and 29: Chapter 3 Cardiac Resynchronization
Page 30 and 31: Chapter 4 because the physician may
Page 32 and 33: Chapter 5 • Disconnection of lead
Page 36 and 37: Chapter 5 Pacemaker Revision to Ski
Page 38 and 39: Chapter 5 ICD Generator Replacement
Page 40 and 41: Chapter 5 individual payers regardi
Page 42 and 43: Chapter 5 Outpatient Procedure Codi
Page 44 and 45: Chapter 5 • Do not report this co
Page 46 and 47: Chapter 5 • Assign modifier 26 to
Page 48 and 49: Chapter 5 • Code 93652 is reporte
Page 52 and 53: Chapter 6 Case Study 3 Procedure De
Page 54 and 55: Chapter 6 resistance 577, threshold

Physician Reimbursement Primer for Cardiac ... - Boston Scientific

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